Intestinal ultrasound is accurate to determine endoscopic response and remission in patients with moderate to severe ulcerative colitis: a longitudinal prospective cohort study.

de Voogd, Floris; van Wassenaer, Elsa A; Mookhoek, Aart; Bots, Steven; van Gennep, Sara; Löwenberg, Mark; D'Haens, Geert R; Gecse, Krisztina B (2022). Intestinal ultrasound is accurate to determine endoscopic response and remission in patients with moderate to severe ulcerative colitis: a longitudinal prospective cohort study. Gastroenterology, 163(6), pp. 1569-1581. Elsevier 10.1053/j.gastro.2022.08.038

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BACKGROUND AND AIMS

Intestinal ultrasound (IUS) is non-invasive, cost-effective and accurate to determine disease activity in ulcerative colitis (UC). In this study we prospectively evaluated IUS for treatment response in a longitudinal cohort by using endoscopy and histology as gold standards.

METHODS

Consecutive patients with moderate-to-severe UC (endoscopic Mayo score (EMS)≥2) starting tofacitinib treatment were included. Patients were evaluated at baseline and after 8 weeks of tofacitinib induction by means of clinical, biochemical, endoscopic (EMS and ulcerative colitis endoscopic index for severity (UCEIS)), histological (Robarts Histopathologic Index (RHI)) and IUS assessments. Readers of IUS, endoscopy and histology were blinded for all other outcomes. The primary outcome was difference in bowel wall thickness (BWT) for endoscopic improvement versus no endoscopic improvement. Endoscopic remission was defined as EMS=0, improvement as EMS≤1 and response as a decrease of EMS≥1.

RESULTS

Thirty patients were included with 27 patients completing follow-up. BWT correlated with EMS (ρ=0.68, p<0.0001), UCEIS (ρ=0.73, p<0.0001) and RHI (ρ=0.49, p=0.002) at both time-points. BWT in the sigmoid was lower in patients with endoscopic remission (1.4mm vs 4.0mm, p=0.016), endoscopic improvement (1.8mm vs 4.5mm, p<0.0001) and decrease in BWT was more pronounced in patients with endoscopic response (-58.1% vs -13.4%, p=0.018). The most accurate cut-off values for BWT were 2.8 mm (AUC:0.87) for endoscopic remission, 3.9 mm (AUC:0.92) for improvement and decrease of 32% (AUC:0.87) for response. The submucosa was the most responsive wall layer.

CONCLUSION

IUS, importantly BWT as the single most important parameter, is highly accurate to detect treatment response when evaluated against endoscopic outcomes.

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